Dialysis Explained

When dialysis usually starts

Dialysis is not triggered by a single number. It is started when symptoms of kidney failure appear or when blood chemistry and fluid balance can no longer be managed with medication — commonly, though not always, when eGFR has fallen below about 10 to 15.

Starting in a planned way is considerably better than starting as an emergency. Planned starts allow the access to be created and to mature first, and give families time to understand the options. This is why nephrologists raise the subject earlier than patients often expect.

Haemodialysis

Blood is drawn from the body, passed through a filter that removes waste and excess fluid, and returned. A typical schedule is three sessions a week, each around four hours, at a dialysis centre.

Access: the part that needs planning ahead

Haemodialysis needs reliable access to the bloodstream. The preferred option is an arteriovenous fistula, created surgically by joining an artery to a vein in the arm. A fistula takes weeks to months to mature before it can be used, which is precisely why the surgery is done well before dialysis is needed. A catheter into a large vein can be used in the meantime, but carries a higher infection risk and is not intended as a long-term solution.

If your doctor has suggested creating a fistula, it does not mean dialysis is starting tomorrow. It means they want the access ready before it is needed, so you never have to begin through a catheter in an emergency.

What a session is actually like

Two needles are placed in the fistula. Most people read, sleep, or use their phone during the session. Blood pressure is checked regularly. Cramping, nausea, or feeling drained towards the end is common, particularly when a lot of fluid has been gained since the last session — which is one reason fluid limits between sessions matter so much.

Peritoneal dialysis

A soft catheter is placed permanently into the abdomen. Sterile fluid is run in, left to draw waste and excess water across the abdominal lining, then drained out. Exchanges are done several times a day by hand, or overnight by a machine while you sleep.

It is done at home, which suits people who work, who live far from a dialysis centre, or who want fewer travel days. It requires a clean space for exchanges and careful technique, because peritonitis is the main risk. Families are trained thoroughly before starting.

Comparing the two

Neither is universally better. The right choice depends on your other medical conditions, your home circumstances, your distance from a centre, and your own preference — which is a legitimate factor, not an afterthought.

Organising life around treatment

• Fluid limits are usually the hardest part. Sambar, rasam, buttermilk, and coffee all count, not only plain water.
• Potassium and phosphorus need managing between sessions. Our Tamil Nadu kitchen guide covers this in practical detail.
• Weight is checked each session — steady gains between sessions are almost always fluid.
• Work is often possible. Evening or night shifts at some centres, and home dialysis, both help.
• Travel needs planning, but transfer to a centre elsewhere can usually be arranged in advance.
• One family member usually becomes the coordinator. Share that role deliberately rather than letting it settle on one person.

What it costs

Dialysis is covered under Ayushman Bharat for eligible families, and the national dialysis programme provides free haemodialysis at district hospitals for eligible patients. Tamil Nadu also operates its own state health insurance scheme. The recurring costs that families most often underestimate are travel and lost earnings for whoever accompanies the patient several times a week.